Thoracic Surgery Department, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 avenue du doyen Lépine, Bron, France.
J Thorac Oncol. 2012 Oct;7(10):1556-62. doi: 10.1097/JTO.0b013e31826419d2.
To describe postoperative complications and long-term outcomes of completion pneumonectomy and highlight prognostic factors.
We retrospectively reviewed the records of 46 patients (38 men, 8 women) who underwent completion pneumonectomy for lung cancer between 1995 and 2009 in one of two thoracic surgery departments. Most were current or former smokers (n = 41; 89%) and did not undergo chemotherapy (n = 38; 83%) or radiotherapy (83%) before surgery.
Complications after surgery were respiratory failure (n = 11; 24.4%), bronchopleural fistula (n = 6; 13%, with no side preference), and empyema (n = 6; 13%). Blood transfusion was necessary for 43% of the cases (n = 20). The day 90 death rate was 15.2% (n = 7). Postoperative staging showed mostly limited disease. Ten patients (21.7%) underwent operation for a second primary cancer, 25 for local recurrence (54.3%), five for microscopically incomplete resection, and six for other reasons. Median overall survival after completion surgery was 30 months (median follow-up: 46.5 months). Among the 15 living patients (33%), 11 are free of disease (24%). In a Cox regression model, factors negatively influencing overall survival were: age older than 65 years (odds ratio [OR] = 2.47; p = 0.012), current smoker status (OR = 2.285; p = 0.033), postoperative pulmonary (OR = 5.144; p = 0.004), cardiac (OR = 3.404; p = 0.033), or parietal wound complications (OR = 5.439; p = 0.016).
Despite its increased postoperative complications and mortality compared with standard pneumonectomy, completion pneumonectomy offers encouraging long-term results. Five main factors seem predictive of shorter overall survival.
描述肺癌患者行全肺切除术的术后并发症和长期预后，并重点分析预后因素。
我们回顾性分析了 1995 年至 2009 年期间在两个胸外科病房中接受全肺切除术的 46 例肺癌患者（38 名男性，8 名女性）的病历记录。大多数患者为当前或既往吸烟者（41 例，89%），术前未接受化疗（38 例，83%）或放疗（83%）。
术后并发症包括呼吸衰竭（11 例，24.4%）、支气管胸膜瘘（6 例，13%，无侧别偏好）和脓胸（6 例，13%）。43%的病例需要输血（20 例）。术后第 90 天死亡率为 15.2%（7 例）。术后分期主要为局限性疾病。10 例（21.7%）患者因第二原发癌行手术治疗，25 例因局部复发（54.3%），5 例因镜下不完全切除，6 例因其他原因。全肺切除术后中位总生存期为 30 个月（中位随访时间：46.5 个月）。在 15 例存活患者中（33%），11 例无疾病（24%）。在 Cox 回归模型中，影响总生存期的因素包括：年龄大于 65 岁（比值比[OR] = 2.47；p = 0.012）、当前吸烟状态（OR = 2.285；p = 0.033）、术后肺部（OR = 5.144；p = 0.004）、心脏（OR = 3.404；p = 0.033）或壁层伤口并发症（OR = 5.439；p = 0.016）。
尽管与标准全肺切除术相比，全肺切除术的术后并发症和死亡率较高，但它仍能提供令人鼓舞的长期预后。有 5 个主要因素似乎可以预测总体生存率较短。
